Abdominal Trauma - Dr. Colucciello

CORE CONCEPTS

• Physical exam unreliable in elderly, intoxicated, and those with distracting injuries.
• Lactate > 2 should raise concern for occult shock in the elderly.
• Gross hematuria and microscopic hematuria with shock requires imaging in the adult.  Many authorities feel that microscopic hematuria requires workup in children.
• Use PECARN rules for abdominal imaging in children with BAT
• Default for penetrating GSW to abdomen is OR;  tangential wounds may be amenable to CT

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Special Circumstances: 

1. Spearing injury
     - duodenal injuries, rectus injury with hernia, pancreatic injury
     - handlebar, ski pole, 
     - duodenal hematoma- CT with oral contrast 
     - pancreatic injury - get lipase (usually presents in delayed fashion)


2. Seatbelt sign
     - Ecchymosis / Bruises ... not just abrasions
     - get CT, give good return precautions or have them come back for check


3. Geriatric
     - VS misleading, abdominal exam insensitive, lactate > 2( sensitive to occult shock) 
     - liberal role for CT
     - low threshold for admit


PECARN Rules: get CT if,
    - Abdominal wall trauma, seatbelt sign
    - GCS< 14
    - Tenderness
    - Chest wall trauma
    - Intoxication,
    - Hematuria
    - Elevated LFT
    - Painful distracting injury